Remifentanil for postoperative analgo-sedation: effects on glycaemia and HOMA score

Introduction

Surgical-related neuroendocrine stress response extends over the postoperative period, inducing insulin resistance and hyperglycaemia [1]. Remifentanil continuous infusion, reducing pain and anxiety, may reduce postoperative insulin resistance and result in better glycaemic control. The aim of the study was to assess trends in glycaemia and HOMA scores in postoperative patients during remifentanil-driven, postoperative analgo-sedation.

Methods

Enrolled patients were those consecutively admitted to a surgical ICU after major abdominal interventions during a 1-month period (July 2009). Group R patients underwent analgo-sedation with continuous remifentanil infusion at the recommended doses [2]. Glycaemia and HOMA scores were evaluated at admission time (T0) and after 12 and 24 hours. Control patients were those who underwent morphine-based continuous analgo-sedation (M Group). Differences in glycaemias and HOMA scores across the two groups were tested with a Student t test (P < 0.05).

Results

The total number of enrolled patients was 100. No differences were found across the groups regarding general and clinical data, particularly age, prevalence of diabetes, and VAS and Ramsay scores during analgo-sedation. No differences were found in glycaemia at T0 and T12, while at T24 the R group patients showed lower glycaemia than controls (99.4 ± 24.7 vs 104.2 ± 17.4 mg/dl, respectively; P = 0.018). No differences either could be found in HOMA scores at T0 and T12, while at T24 the R group patients had lower scores than control patients (1.962 ± 0.19 vs 2.414 ± 0.81, respectively; P = 0.019).

Conclusions

Remifentanil-based analgo-sedation was associated with lower glycaemia and HOMA score in patients following major abdominal surgery, particularly at 24 hours from ICU admission. HOMA scores showed that morphine-treated patients were insulin resistant, although normoglycaemic. A better control of the neuroendocrine stress response in patients analgo-sedated with remifentanil might explain these results.